Steroid Stress Dosing and Weaning Clinical Pathway – Steroid Potency, Physiologic Dosing and Symptoms

Steroid Stress Dosing and Weaning Clinical Pathway

Steroid Potency, Physiologic Dosing

  • There are several commonly used glucocorticoid preparations, each with different indications and each with different potencies.
  • Physiologic dosing of hydrocortisone is 8-12 mg/m2/day.
  • Considering the physiologic production of glucocorticoids and knowing the potency of available glucocorticoid preparations, clinicians can calculate how the prescribed dose compares to the expected cortisol secretion by the adrenal glands.
  • The table below lists the common steroid preparations and their potency relative to hydrocortisone.
  • Note that cortisol and hydrocortisone should be considered to have equivalent potencies.
Glucocorticoid Approximate Equivalent Dose (mg) Physiologic Dose (mg/m2/day)
Hydrocortisone 20 10
Prednisone/Prednisolone 5 2
Methylprednisolone 4** 2
Dexamethasone 0.75 0.4
Vamorolone and Deflazacort Consult Endocrinology

**Technical conversion from prednisone/prednisolone to methylprednisolone is 1.25:1 ratio; however, in clinical practice, use a 1:1 ratio for ease of conversion and have not witnessed adverse effects.

For vamorolone and deflazacort, consult Endocrinology.